Sexual Violence in Times of War: Part 2

Sexual violence against women in war and its aftermath can have almost inestimable short and long-term negative health consequences. As a result of the systematic and exceptionally violent gang rape of thousands of Congolese women and girls, doctors in the DRC are now classifying vaginal destruction as a crime of combat. Many of the victims suffer from traumatic fistula — tissue tears in the vagina, bladder and rectum. Additional long-term medical complications for survivors may include uterine prolapse (the descent of the uterus into the vagina or beyond) and other serious injuries to the reproductive system, such as infertility, or complications associated with miscarriages and self-induced abortions. Rape victims are also at high risk for sexually transmitted infections (STIs). Health clinics in Monrovia, Liberia, reported in 2003 that all female patients — most of whom said they had been raped by former government soldiers or armed opposition — tested positive for at least one sexually transmitted infection. Untreated STIs can cause infertility — a dire consequence for women and girls in cultures where their value is linked to reproduction. STIs also increase the risk of HIV transmission. HIV/AIDS is among the most devastating physical health consequences for survivors of sexual violence — as evidenced by the continued suffering of women in Rwanda. In a study of over 1,000 genocide widows undertaken in the year 2000, 67 percent of rape survivors were HIV-positive. In the same year, the United Nations Secretary-General concluded, “Armed conflicts … increasingly serve as vectors for the HIV/AIDS pandemic, which follows closely on the heels of armed troops and in the corridors of conflict.” Despite the level of recognition of the urgency of the problem of HIV/AIDS in war, insufficient resources have been dedicated to addressing the issue. In Rwanda, as elsewhere, treatment for rape victims infected with HIV has been characterised as “too little, too late.” The story of one HIVpositive victim of the genocide illustrates the tragic consequences:

“Since I learned I was infected [in 1999], my husband said he couldn’t live with me. He divorced me and left me with three children, so now I don’t know how to pay for food, rent, school and so on. I have no family left. My six-year-old has many health problems, and she must have HIV. She should be on antiretrovirals, but there isn’t the money. Since I was married after the war, it is difficult for me to access help from the Genocide Survivor’s Fund. My greatest worry is what will happen to my children if I die. I want to get sponsors for them, so at least I can die in peace.”

The challenges of meeting the myriad health needs of survivors of warrelated sexual assault are complicated by the absence of adequate facilities and trained staff in many war-torn settings. In research conducted in post-conflict Timor Leste and Kosovo, and among internally displaced women in Colombia, over two-thirds of women interviewed reported that reproductive-health services were difficult to access. Even where services do exist, they may not be free — as is the case in many countries in Africa, where state-run health centres operate on a cost-recovery basis. Moreover, many health clinics are constructed with open waiting areas where women and girls may be expected to disclose their reasons for seeking care; in the absence of confidentiality, they are likely to conceal their victimisation. Health workers’ beliefs that it is their responsibility to “prove or disprove” rape is also a limiting factor in quality of care. In some settings, a woman seeking medical treatment may be required first to report her case to the police in order to get a medical referral. This prerequisite, in turn, may expose women to further violence. Rape victims in Darfur, for example, have been arrested for “illegal” pregnancies (occurring outside the context of marriage). One 16-year old Sudanese girl, who had already suffered the rejection of her family and fiancé, endured additional abuse at the hands of police:

“When I was eight months pregnant from the rape, the police came to my hut and forced me with their guns to go to the police station. They asked me questions, so I told them that I had been raped. They told me that as I was not married, I will deliver this baby illegally. They beat me with a whip on the chest and back and put me in jail. There were other women in jail who had the same story. During the day, we had to walk to the well four times a day to get the policemen water, clean and cook for them. At night, I was in a small cell with 23 other women. I had no other food than what I could find during my work during the day. And the only water was what I drank at the well. I stayed 10 days in jail and now I have to pay the fine — 20,000 Sudanese dinar [$65] they asked me. My child is now two months old.”

For those who are subject to discrimination by family and community, and who also do not receive basic psychological support, the emotional effects of their violation may be as debilitating as any physical injuries. Many rape survivors in Rwanda reportedly “still live under a constant shadow of pain or discomfort which reduces their capacity to work, look after and provide for their families.” One such survivor, who was gang raped and beaten unconscious during the genocide, woke up only to witness the killing of people all around her. Ten years later, she says:

“I regret that I didn’t die that day. Those men and women who died are now at peace whereas I am still here to suffer even more. I’m handicapped in the true sense of the word. I don’t know how to explain it. I regret that I’m alive because I’ve lost my lust for life. We survivors are broken-hearted. We live in a situation which overwhelms us. Our wounds become deeper every day. We are constantly in mourning.”

The implications of such testimony make clear the fact that programming to assist survivors is imperative to any lasting efforts at reconstructing the lives and livelihoods of individuals, families and communities in the wake of armed conflict. In most conflict-affected settings, however, human rights and humanitarian activists are still fighting to ensure that the most basic services are accessible. The ultimate goal — putting an end to the epidemic of sexual violence against women and girls during war — seems an even more distant aspiration than developing adequate response services.

Assisting and protecting survivors

International humanitarian initiatives aimed at addressing violence against women in refugee, internally displaced and post-conflict settings are relatively new. Most have been introduced only in the last 10 years. Particularly during the late 1990s, a number of relatively small-scale but nonetheless vital projects were implemented in various sites around the world. The lessons learned from these efforts gave rise to a theoretical model, currently promoted by UNHCR and others, that recognises the importance of integrating prevention and response programming within and across service-delivery sectors, specifically in the areas of health, social welfare, security and justice. In other words, survivors must have access to medical care as well as psychosocial assistance; they should be able to rely on the protection of the police, peacekeepers and local military; and they are entitled to legal assistance should they choose to prosecute those who perpetrate violence against them. Addressing sexual violence also requires national education and sensitisation — at the family and community level and at the level of service provision — so that doctors, lawyers, judges and police are able to respond to survivors efficiently, effectively and supportively. It further requires advocating for improved legislation to protect women and girls, as well as policies that support gender equity and equality.

While the broad outline of roles and responsibilities within this “multisectoral model” provides a general framework for addressing violence against women, an assessment undertaken in 2001 concluded that the implementation of the model was weak in virtually every conflict-affected setting around the world. Foremost among the limitations to establishing multisectoral programming was the failure — at both the international and national levels — to prioritise violence against women as a major health and human rights concern. The result was a lack of financial, technical and logistical resources necessary to tackle the issue. Many survivors, the 2001 assessment observed, were not receiving the assistance they needed and deserved, nor was sufficient attention being given to the prevention of violence. The outcomes of an independent experts’ investigation spearheaded by the United Nations Development Fund for Women the following year echoed these findings in their conclusion “that the standards of protection for women affected by conflict are glaring in their inadequacy, as is the international response.”

These inadequacies persist even today. However, the number of fieldbased initiatives addressing the issue of sexual violence against women and girls continues to grow, even against a wearisome backdrop of limited funding. Methodologies are being refined by many humanitarian organizations to try to extend and improve services for survivors, as well as to build the capacity of local agencies to take on the issue. Standardised procedures for medical management of rape are being adopted in an increasing number of settings. Training modules have been developed to build local capacity to meet the psychosocial needs of survivors. Efforts are being made, most evidently in post-conflict settings but also in some refugee settings, to support legal reforms that would provide greater protection against multiple types of gender-based violence against women and girls.

Widespread community-based education aimed at changing attitudes and behaviours that promote sexual and other forms of violence against women has been carried out in a number of settings. Research on the nature and scope of the problem has also multiplied in recent years, and is bringing pressure to bear on international actors as well as on states to take more aggressive measures to address violence against women in conflict and its aftermath.

In addition, several high-level international initiatives are currently underway to promote more coordinated and comprehensive action by humanitarian aid organizations. New guidelines issued by a task force of the United Nations Inter Agency Standing Committee (IASC) provide detailed recommendations for the minimum response required to address sexual violence in emergencies and hold all humanitarian actors responsible for tackling the issue in their respective areas of operation. The IASC released a statement in January 2005 reconfirming their commitment to “urgent and concerted action aimed at preventing gender-based violence, including in particular sexual violence, ensuring appropriate care and follow-up for victims/survivors, and working towards holding perpetrators accountable.”

To this end, a global initiative to “stop rape in war” is being developed collaboratively by United Nations entities and nongovernmental organizations. The two major pillars of the initiative include conducting advocacy at the international, regional, and local levels, and strengthening programming efforts among those currently engaged in addressing the issue of sexual violence in conflict. One of the notable outcomes of the proposed initiative is to reduce the prevalence of rape in target countries by at least 50 percent by 2007. Such ambitions will require a “quantum shift” in approaches to sexual violence in war, most especially in terms of prioritising all efforts to end the levels of impunity that have given rise to the “shocking scale and stubborn persistence” of the violence.

The final frontier: ending impunity

Along with an increase in field-based programming, the last decade has produced significant advances in international standards and mechanisms of accountability for those who commit sexual violence. International criminal tribunals for Rwanda and the former Yugoslavia have prosecuted sexual violence as crimes of genocide, torture, crimes against humanity and as war crimes. The Rome Statute of the recently established International Criminal Court (ICC) has enumerated rape, sexual slavery and trafficking, enforced prostitution, forced pregnancy, enforced sterilisation and other forms of sexual violence and persecution as crimes against humanity and as war crimes. The ICC is initiating investigation into cases from several conflict-affected countries. Another groundbreaking advance was the United Nations Security Council’s adoption of Resolution 1325 in 2000, which specifically “calls upon all parties to armed conflict to take special measures to protect women and girls from gender-based violence, particularly rape and other forms of sexual abuse, and all other forms of violence in situations of armed conflict.” Since that time, the United Nations Secretary-General has submitted two reports to the United Nations Security Council on the implementation of Resolution 1325. While these reports concede that much remains to be done, especially in terms of holding states accountable for the actions of fighting forces and in increasing the level of participation of women in all stages of peace-building, they also note that major advances have been made in introducing codes of conduct that establish “zero tolerance” for all United Nations personnel, including peacekeepers, who might sexually exploit those they are meant to serve. Since these codes of conduct were implemented, action has been taken against offenders in a number of countries, such as the DRC, where an inquiry into allegations of sexual exploitation committed by over 100 peacekeepers is underway. However, grave problems with impunity persist in virtually every conflict-affected setting around the globe. International tribunals can only prosecute a fraction of cases, and many national governments do not have the resources or the commitment to pursue the perpetrators of sexual crimes against women. In some cases national jurisdiction does not extend to foreign fighting forces who commit abuses within their territory. In others, governments do little to support victims in coming forward. Evidentiary requirements often mean that the burden of proof lies with the victim. Some must pay for legal assistance. Where forensic evidence is required, healthcare providers must be able to collect it in a timely manner and be prepared to present that evidence at a trial. Police or relevant security forces must be trained to investigate and appropriately document their findings. The frustrating reality for many survivors of sexual crimes in conflict-affected settings around the world is that there are no systems to ensure basic protection to survivors, let alone access to justice.

Such impunity both reflects and reinforces the widespread cultural norms that acquiesce to the inevitability of violence against women and girls whether in times of peace or of war. And it is these norms that must be targeted aggressively in order to ensure reductions in levels of abuse:

“In a world where sex crimes are too often regarded as misdemeanours during times of law and order, surely rape will not be perceived as a high crime during war, when all the rules of human interaction are turned on their heads, and heinous acts regularly earn their perpetrators commendation. … What matters most is that we combine the new acknowledgement of rape’s role in war with a further recognition: humankind’s level of tolerance for sexual violence is not established by international tribunals after war. That baseline is established by societies, in times of peace. The rules of war can never really change as long as violent aggression against women is tolerated in everyday life.”

In a world where thousands of women and girls suffer sexual violence committed with impunity in the context of conflict, the message needs to be made clear: A single rape constitutes a war crime.